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General NPI Number Information
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NPI Number | 1609274430
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Entity Type | Organization
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Legal Business Name | AUTISM, BEHAVIOR, AND PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 12/10/2014
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Last Update Date | 12/10/2014
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Provider Practice Location Address
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Address Line | 400 SHAWNEE ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-1955
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Country | US
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Telephone | 913-206-8154
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Fax | 913-608-5756
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Provider Business Mailing Address
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Address Line | 13115 W 74TH ST
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City | SHAWNEE
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State | KS
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Zip | 66216-4412
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Country | US
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Telephone | 913-206-8154
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Fax | 913-608-5756
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. LISA DYAN WALSH
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Credential | PHD
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Telephone | 913-206-8154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1031397
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 932
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License Number State | KS
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